Friday, August 12, 2016

HK CHP: Additional Details On China's July H7N9 Cases

Credit CDC

#11,628

Hong Kong's CHP has published a notification on the 5 H7N9 cases reported by China yesterday (seeChina: 5 H7N9 Cases In July) that adds some additional information, including the ages and location of these 5 cases.

We also learn that two of the cases - 13-year-old girl and a 68-year-old woman - lived together, although it isn't clear whether they shared a common exposure or if one passed the infection to the other.

(note) Although it's vague, on closer reading it appears the 13 year-old may have had contact with the third case from Beijing, which would make a cluster of 3.

Where things get even murkier, we saw two cases reported at the end of July (see here), and one of those (F 54) isn't included in this list at all, while details on the the other one differ (age and location) enough to cast some doubt whether they are a match to the 36 year old listed today from Beijing.

The lack of details, late reporting, and inconsistencies in case descriptions make it very difficult to track these cases accurately, although Sharon Sanders on FluTrackers had done an admirable job over the years with her H7N9 line list.

As I mentioned yesterday, over the past 3 years we've only averaged 3 to 4 cases reported by China over the summer months (June, July, August), while this year we've already seen 12 (or possibly 13+).Whether this increase speaks to better testing and surveillance, or to a change in the virus's behavior, is unknown. The CHP, however, continues to warn:

"In view of additional human cases reported on the Mainland with
detection of human cases in previously unaffected areas in warmer
months, as well as the detection of positive samples of faecal droppings
of live poultry in Hong Kong and the positive environmental sample in
Macau in June, the public should remain vigilant. Travellers to the
Mainland and other avian influenza-affected areas in the summer vacation
should not visit poultry markets, and should avoid contact with poultry
and their droppings."

Hopefully we'll get more details from the next WHO H7N9 update, but for now we have the following from Hong Kong's CHP.

The Centre for Health Protection (CHP) of the Department of Health
(DH) today (August 12) received notification of five additional human
cases of avian influenza A(H7N9) from the National Health and Family
Planning Commission (NHFPC), and again urged the public to maintain
strict personal, food and environmental hygiene both locally and during
travel.

According to the NHFPC, two patients in Fujian were a 79-year-old
man who had visited a market and died on July 10, and a 78-year-old man
who had poultry exposure and is currently in serious condition. A
patient in Beijing is a 35-year-old male who had poultry exposure in
Jiangxi and is currently in serious condition. Two patients in Hebei are
a 13-year-old girl and a 68-year-old woman, and both are in stable
condition. They live together and the 13-year old patient had
accompanied the above patient in Beijing back to Jiangxi.

" H7N9 has become enzootic in poultry on the Mainland. According to
the Ministry of Agriculture, from January 2015 to May 2016, poultry and
environmental samples collected from markets in Anhui, Fujian,
Guangdong, Hubei, Hunan, Jiangsu, Jiangxi, Jilin, Shanghai and Zhejiang
tested positive for H7N9. The Food and Agriculture Organization of the
United Nations revealed that positive samples on the Mainland were
mainly taken from live bird markets, vendors and some commercial or
breeding farms," a spokesman for the CHP said.

"In view of additional human cases reported on the Mainland with
detection of human cases in previously unaffected areas in warmer
months, as well as the detection of positive samples of faecal droppings
of live poultry in Hong Kong and the positive environmental sample in
Macau in June, the public should remain vigilant. Travellers to the
Mainland and other avian influenza-affected areas in the summer vacation
should not visit poultry markets, and should avoid contact with poultry
and their droppings," the spokesman added.

From 2013 to date, 775 human cases of avian influenza A(H7N9) have
been reported by the Mainland health authorities, while since October
2015 to date, 118 have been recorded.

"We will remain vigilant and work closely with the World Health
Organization and relevant health authorities to monitor the latest
developments," the spokesman said.(Continue . . . )